The value of an additional hypoechoic lesion-directed biopsy core for detecting prostate cancer

OBJECTIVE

To determine the value of a hypoechoic lesion (HL)‐directed biopsy in addition to a systematic sextant biopsy for detecting prostate cancer.

SUBJECTS AND METHODS

Within the European Randomized study of Screening for Prostate Cancer, 37 627 assays for prostate‐specific antigen (PSA) were done in men aged 55–75 years (screening round 1–3, interval 4 years). A PSA level of ≥3.0 ng/mL prompted a systematic transrectal ultrasonography (TRUS)‐guided lateralized sextant biopsy (4986 biopsy sessions were evaluated). If there was a HL, an additional lesion‐directed biopsy was taken.

RESULTS

At the initial screening, 1840 men were biopsied and 532 cancers were detected (28.9%). Of the men biopsied, 436 had a HL and an additional biopsy (23.7%). In these men, 230 cancers were detected (52.8%). In 3.5% (eight of 230) only the HL‐directed core showed malignancy. At the repeat and third screening, respectively, 19.3% and 18.9% of the men biopsied had prostate cancer, 16.8% and 9.3% had an HL and the additional core detected two (2.2%) and one (5.9%) cancers. At the first screen most cancers found by the additional core were clinically relevant. In later screens these cancers seemed to be minimal.

CONCLUSION

The performance of TRUS as a screening tool is poor. The value of the additional core was limited as only 3.5% of the visible cancers were detected solely by the additional biopsy (round 1). However, a substantial part of these cancers were clinically relevant and would have been missed without the additional biopsy. This finding was less clear in screening round 2 and 3, even in men who were not previously biopsied.     

The independent impact of extended pattern biopsy on prostate cancer stage migration

PURPOSE: There are many factors impacting stage migration for prostate cancer. The number of prostate core biopsies is known to increase detection of prostate cancers. It is still unknown whether the number of biopsies is an independent predictor of tumor size. This is important as a number of studies show that tumor volume is an independent predictor of cancer progression. MATERIALS AND METHODS: Using the University of California, San Francisco Urologic Oncology database, a retrospective review of 378 patients undergoing radical prostatectomy by a single surgeon during 2000 to 2003 was performed. Patient and tumor specific variables including age, prostate specific antigen (PSA), number of biopsies, biopsy Gleason grade, tumor volume in the surgical specimen and surgical specimen tumor grade were studied. Univariate and multivariate statistical methods including multiple and logistic regression were used to characterize patients by the number of biopsy cores. Tests of significance to identify predictors of tumor size were based on the partial F statistic and the likelihood ratio test. RESULTS: A total of 317 eligible patients were studied, of whom 119 had 6 biopsies and 198 had more than 6 biopsies. The 2 groups of patients were evenly matched in terms of age, PSA and Gleason sum, with no statistically significant differences observed. On univariate analysis, mean tumor volume was larger for patients receiving 6 core biopsies vs greater than 6 core biopsies (3.85 vs 2.04 cc, p = 0.0009). Additionally, statistically significant differences were observed when comparing median tumor volumes, as well as excluding extremely large volume tumors. On multivariate analysis the number of biopsies performed (6 vs more than 6), was an independent predictor of tumor size (p = 0.006), controlling for primary Gleason score, Gleason sum, PSA as a continuous or categorical variable, year of biopsy and year of surgery. CONCLUSIONS: The use of extended pattern prostate biopsy templates results in the detection of smaller volume prostate cancers, independent of PSA and Gleason grade. These biopsy templates have contributed to the downward stage migration of prostate cancer detection and may possibly contribute to the risk of over detection.     

Predictors of prostate cancer after initial negative systematic 12 core biopsy

PURPOSE: We determined the cancer detection rate at initial systematic 12 core (S12C) biopsy and identified features associated with cancer at repeat S12C biopsy after an initial negative S12C biopsy in patients with prostate specific antigen (PSA) parameters associated with a higher risk of prostate cancer. MATERIALS AND METHODS: Between February 1999 and June 2002, 841 patients underwent initial S12C biopsy. Of these patients 99 underwent repeat S12C biopsy after initial negative S12C because of a percent free-to-total PSA of 15.0 or less and/or a yearly PSA velocity of 0.75 ng/ml or greater. The association between parameters revealed by initial biopsy and cancer at repeat biopsy was assessed. RESULTS: Of the 99 patients 21 (21.2%) had cancer at repeat biopsy. Age (p = 0.01), PSA transitional zone density (p = 0.05), and high grade PIN at initial biopsy (p = 0.01) were associated with cancer at repeat biopsy. CONCLUSIONS: In this select group of patients with PSA parameters associated with a higher risk of prostate cancer the cancer detection rate after initially negative S12C biopsy was 21%. Patients with high grade PIN on initial biopsy, advanced age and higher PSA transition zone density are at increased risk for cancer at repeat biopsy. Larger prospective studies are required to confirm these results and construct a nomogram that determines the probability of finding prostate cancer at subsequent biopsy.     

经会阴前列腺穿刺与经直肠前列腺穿刺活检在前列腺癌诊断的初探

目的 对比经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的阳性率及并发症。方法 回顾分析2017年1月到2019年12月行前列腺穿刺活检的病例,经直肠组187例,经会阴组68例。结果 经直肠组阳性穿刺率为34.7%,经会阴组阳性穿刺率为29.4%,两组无统计学差异（P>0.05）。穿刺后经直肠组和经会阴组的血尿发生率分别为40.1%、42.6%,尿潴留发生率分别为6.9%、7.3%,直肠出血发生率分别为1.1%、0%,差别无统计学意义（P>0.05）。穿刺后经直肠组和经会阴组的会阴肿胀的发生率分别为2.6%、13.2%,两组有统计学差异（P<0.05）。结论 超声引导下经直肠、经会阴前列腺穿刺活检均为前列腺癌诊断的有效方法。两者穿刺阳性率无明显差异,但并发症各有特点。     

Transrectal biopsy of the prostate for the detection of non-palpable prostate cancer: a comparison of 6 versus 12 core biopsy

PURPOSE: Several studies suggest that extended transrectal prostate biopsy more than 6 core may improve the cancer detection rate. We compared 6 and 12 core biopsies to determine the impact on cancer detection and complication rate. PATIENTS AND METHODS: We retrospectively evaluated 150 patients who underwent transrectal ultrasound guided prostate biopsy between January 1999 and December 2003. Patients who were suspected to have prostate cancer on digital rectal examination and/or who had a history of previous prostate biopsy were excluded. Sextant biopsy was performed in 52 patients (6 core group) and 12 core biopsy was performed in 98 patients (12 core group). The cancer detection rate and post-biopsy complication rate were estimated. RESULTS: There was no significant difference in the overall cancer detection rate between 6 and 12 core groups (17 of 52 men or 32.7% versus 35 of 98 men or 35.7%). In addition, even if calculated the cancer detection rate stratified according to a PSA of 0 to 4.0, 4.1 to 10.0 and greater than 10.0 ng/ml, there was no significant difference between both groups. There was also insignificant difference of complication rate between both groups. CONCLUSIONS: The results of our study showed that there was no significant difference in cancer detection and complication rate between both groups.     

Effect of dimensions and volume of the prostate on cancer detection rate of 12 core prostate biopsy

Purpose To evaluate if volume or any of the three dimensions of prostate influences cancer detection rate by 12-core transrectal ultrasound (TRUS) guided prostate biopsy. Materials and methods We have searched our database for patients who underwent 12 core TRUS guided prostate biopsy with PSA values between 4.0 and 9.9 ng/ml, benign digital exam and no suspicious lesions at TRUS. The measurements of three dimensions and volume of the prostate of 99 patients were correlated with cancer detection rates of biopsy. Results There were no statistically significant differences between patients with prostate cancer or with benign histopathologic result for mean age, PSA and % PSA. Patients without cancer had a significantly higher mean prostate volume (58.88 cc) than patients with cancer (48.85 cc) (P = 0.038). A volume of 48.5 cc was determined as a cut-off value above which cancer detection rate decreases. Of the three dimensions, only the difference for the craniocaudal dimension between benign and malignant groups was marginally significant (P = 0.052). Conclusions With 12 core biopsy, cancer detection rate is lower in patients with prostates larger than 48.5 cc. Further studies comparing biopsy results with prostatectomy specimens can clarify whether these results necessitates higher number of cores for such patients.     

Comparison of transrectal fine-needle aspiration cytology and core needle biopsy in diagnosis of prostate cancer

One hundred sixty-nine transrectal fine-needle aspirations of the prostate gland were performed in 166 patients over a two-year period. The results were compared with simultaneous core needle biopsy performed in all but 4 patients. Forty-seven (28%) aspirations were either unsatisfactory or inconclusive. Of the remaining 122 (72%) patients in whom a cytologic diagnosis could be made, core biopsy was available in 120. Aspiration cytology was 87 percent sensitive and 96 percent specific with an overall agreement of 93 percent with core biopsy. No major complications occurred. We conclude that fine-needle aspiration of the prostate is accurate, safe, and cost-effective, and greater application of this technique is encouraged.     

Defining prostate cancer risk before prostate biopsy

Prostate cancer is the most commonly diagnosed cancer in men. At present, patients are selected for prostate biopsy on the basis of age, serum prostate specific antigen (PSA), and prostatic digital rectal examination (DRE) findings. However, due to limitations in the use of PSA and DRE, many patients undergo unnecessary prostate biopsy. A further problem arises as many patients are diagnosed and treated for indolent disease. This review of the literature highlights the strengths and weaknesses of existing methods of prebiopsy risk stratification and evaluates promising serum, urine, and radiologic prostate cancer biomarkers, which may improve risk stratification for prostate biopsy in the future.     

The impact of obesity on prostate cancer

Increasing prevalence of obesity in many parts of the world emphasizes the importance of learning more about the relationship between obesity and prostate cancer (PC). The present paper reviews the impact of obesity on PC using knowledge obtained from the available literature. Search of published literature in PUBMED database. Adipose tissue constitutes an active endocrine and metabolic organ which may be relevant in the development and progression of PC by different potential mechanisms. Furthermore, obesity could have an impact on the outcome of different treatment modalities for PC, both functionally as anatomically. Obesity is a growing problem, however, the exact role in the development and progression of PC has not been elucidated. Regarding the optimal treatment of PC in obese patients, comparative prospective studies are needed.     

Optimizing prostate cancer detection during biopsy by standardizing the amount of tissue examined per core

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? The main goal of a prostate biopsy is to identify clinically relevant prostate cancer with the lowest possible morbidity from the procedure. Over time, many have tried different variations in the procedure in an attempt to find the optimal methodology for performing prostate biopsies. These changes include better equipment in helping optimize cancer localization, varying the number of cores in efforts to improve cancer detection, and sampling various areas of the prostate to find cancer that might be difficult to identify. To our knowledge we are the first to describe performing prostate biopsies by keeping the sampling size constant and varying the number of cores based on the size of the prostate. The study adds a variation in the current techniques used for prostate biopsies. In certain situations, using a standard number of cores makes obtaining proper sampling of a prostate difficult. We propose a methodology in performing prostate biopsies that will allow for standardization of the tissue per core analysed, thus improving the sampling of the prostate.

OBJECTIVE

? To investigate the effect on cancer detection by varying the number of cores taken for prostate biopsy according to the size of the prostate.

PATIENTS AND METHODS

? A retrospective review of a prospectively registered prostate biopsy database identified 3040 consecutive patients undergoing prostate biopsy at a Veterans Administration Hospital between 1994 and 2008. ? Of 2224 biopsies, 681 (31%) were found to have cancer and 1540 (69%) had negative biopsies. ? Prostate volume to biopsy core ratios (volume/number of cores) were derived and a comparative analysis was performed to determine the impact on cancer detection rates.

RESULTS

? The median prostate volume was significantly smaller for those patients diagnosed with prostate cancer than for those with negative biopsies (33 vs 43 cc, P= 0.01). ? The median number of cores was the same for both groups of patients (median 12, P= 0.66). ? The median transrectal ultrasonography TRUS size/core ratio was 3.5 [interquartile range (IQR) 2.5] for patients with identified cancer as compared with 4.7 (IQR = 3.9) for those with negative biopsies (P= 0.000). ? On multivariable logistic regression analysis TRUS size/core ratio had a significant impact on cancer detection with a relative risk ratio of 1.29 (95% confidence interval, 1.1–1.5, P= 0.001) even when controlled for age, race, prostate volume, digital rectal examination and prostate‐specific antigen level.

CONCLUSIONS

? Prostate cancer detection can be enhanced by individualizing the number of cores performed to a real‐time prostate volume sampling. ? The present study emphasizes that optimal cancer detection rates were observed when a ratio of 3.5 cc per tissue core was achieved. ? Proper prospectively designed studies must be performed to further validate these findings.